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Muh, Carrie Rebecca

Overview:

Carrie R. Muh is a Pediatric Neurosurgeon specializing in the surgical treatment of epilepsy. She treats children with a wide range of neurosurgical disorders including brain and spinal cord tumors, moya moya, craniosynostosis, Chiari malformation, spina bifida and hydrocephalus. 

Dr. Muh grew up in California and began scientific research in high school as part of a NASA Student Space Biology initiative. She went on to study at the Massachusetts Institute of Technology (MIT) where she earned two Bachelor's degrees, in Biology and Political Science. During her undergraduate studies, she worked in the laboratory of DNA-repair scientist Dr. Graham Walker. Dr. Muh also earned a Master's degree in Political Science with a concentration in health policy. After graduation, she spent 8 months working on liver cancer research at the Shanghai Cancer Institute in Shanghai, China, returning to attend medical school at Columbia University's College of Physicians and Surgeons. While at Columbia, Dr. Muh spent a year working in the Gabriel Bartoli Brain Tumor laboratory run by Dr. Jeffrey Bruce, and taught the medical student neuroanatomy review course.
Dr. Muh did her neurosurgery residency at Emory University Hospital and her fellowship in Pediatric neurosurgery at Emory/Children's Healthcare of Atlanta (CHOA). During her residency, she spent time in the pediatric brain tumor laboratory of Dr. Donald Durden. She came to Duke as an Assistant Professor in Neurosurgery and Pediatrics in the summer of 2011 after finishing her fellowship. She is currently the director of education for the medical students within the Department of Neurosurgery. 

Dr. Muh's current research projects focus on developing new techniques for the treatment of hydrocephalus and noninvasive measurement of intracranial pressure (ICP). She recently won a Coulter Grant to work with collaborators in the Department of Biomedical Engineering to create a SmartShunt, a CSF-shunt which will permit noninvasive measurement of intracranial pressure; and is a team leader on a Bass Connections grant to investigate the use of oculomotor assessments to noninvasively diagnose sports-related traumatic brain injury (TBI). She is also collaborating with engineers and radiologists to develop a new MRI technique to determine elevated ICP and find subtle evidence of traumatic brain injury. 

Positions:

Assistant Professor of Neurosurgery

Neurosurgery
School of Medicine

Assistant Professor in Pediatrics

Pediatrics
School of Medicine

Faculty Network Member of the Duke Institute for Brain Sciences

Duke Institute for Brain Sciences
Institutes and Provost's Academic Units

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2003

M.D. — Columbia University

Intern, Neurosurgery, Surgery, Neurology

Emory University School of Medicine

Resident, Neurological Surgery

Emory University School of Medicine

Fellow, Pediatric Neurological Surgery

Emory University School of Medicine

Publications:

Temporary Lumbar Drain as Treatment for Pediatric Fulminant Idiopathic Intracranial Hypertension.

Fulminant idiopathic intracranial hypertension (FIIH) is a subtype of idiopathic intracranial hypertension (IIH) characterized by rapid, severe, progressive vision loss. Surgical intervention is often performed either as a cerebrospinal fluid (CSF) shunt procedure or an optic nerve sheath fenestration or, at times, both. These surgical procedures carry a significant risk of morbidity and failure. We present 2 patients in whom a temporary lumbar drain was successfully used in the management of medically undertreated pediatric FIIH, and circumvented the need for surgical intervention.

Authors
Jiramongkolchai, K; Buckley, EG; Bhatti, MT; Muh, CR; Wiggins, RE; Jiramongkolchai, P; El-Dairi, MA
MLA Citation
Jiramongkolchai, K, Buckley, EG, Bhatti, MT, Muh, CR, Wiggins, RE, Jiramongkolchai, P, and El-Dairi, MA. "Temporary Lumbar Drain as Treatment for Pediatric Fulminant Idiopathic Intracranial Hypertension." Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society (October 25, 2016).
PMID
27787461
Source
epmc
Published In
Journal of Neuro-Ophthalmology
Publish Date
2016

Preface to Clinical Neurosurgery Volume 63, Proceedings of the Congress of Neurological Surgeons 2015 Annual Meeting.

Authors
Tomei, KL; Hankinson, TC; Muh, CR; Dumont, AS; Cheshier, SH; Upadhyaya, C; Choudhri, O
MLA Citation
Tomei, KL, Hankinson, TC, Muh, CR, Dumont, AS, Cheshier, SH, Upadhyaya, C, and Choudhri, O. "Preface to Clinical Neurosurgery Volume 63, Proceedings of the Congress of Neurological Surgeons 2015 Annual Meeting." Neurosurgery 63 Suppl 1 (August 2016): N1-.
PMID
27399578
Source
epmc
Published In
Neurosurgery
Volume
63 Suppl 1
Publish Date
2016
Start Page
N1
DOI
10.1227/neu.0000000000001301

127 Multimodality Word-Finding Distinctions in Pediatric Cortical Stimulation Mapping.

Recently, auditory naming has become a part of cortical stimulation mapping (CSM) to provide a comprehensive language map prior to resection in epilepsy patients. Modality-specific language sites have been found using CSM in adult epilepsy patients, but research in the pediatric population is limited. Here, we demonstrate distinctions between visual and auditory modalities and identify where errors are most likely to occur in pediatric patients.A series of 23 pediatric epilepsy patients (14 female; mean age 12.6 + 3.5 years, 6-18 years) underwent CSM by using visual (n = 23) and auditory (n = 16) naming paradigms. Mixed-effects logistic regression was used with the response being the indicator of an error on an individual trial. We adjusted for patient-specific effects using random effects, and included fixed effects for Region, Modality, interactions between Modality and Region, and age <14 years.No evidence was found to support differences in errors due to age. Statistically significant differences were found by Modality, with auditory naming having a 1.43 higher odds of identifying errors (95% confidence interval [CI], 1.10-1.87, P = .0085) compared with visual naming. Probabilities of visual and/or auditory naming errors varied significantly among regions (P = .002). The highest probability of detecting an error was in the PolMTG under Auditory and Visual modalities (0.48 and 0.39, respectively).The auditory naming modality is more sensitive in detecting errors than visual naming in pediatric epilepsy patients. The PolMTG shows the most naming errors regardless of age or modality, suggesting that CSM mapping with both modalities is necessary to obtain a comprehensive language map before resection.

Authors
Chou, ND; Serafini, S; Grant, GA; Clyde, M; Komisarow, J; Muh, CR
MLA Citation
Chou, ND, Serafini, S, Grant, GA, Clyde, M, Komisarow, J, and Muh, CR. "127 Multimodality Word-Finding Distinctions in Pediatric Cortical Stimulation Mapping." Neurosurgery 63 Suppl 1 (August 2016): 152-.
PMID
27399406
Source
epmc
Published In
Neurosurgery
Volume
63 Suppl 1
Publish Date
2016
Start Page
152
DOI
10.1227/01.neu.0000489697.88290.88

Preface to Clinical Neurosurgery Volume 63, Proceedings of the Congress of Neurological Surgeons 2015 Annual Meeting.

Authors
Tomei, KL; Hankinson, TC; Muh, CR; Dumont, AS; Cheshier, SH; Upadhyaya, C; Choudhri, O
MLA Citation
Tomei, KL, Hankinson, TC, Muh, CR, Dumont, AS, Cheshier, SH, Upadhyaya, C, and Choudhri, O. "Preface to Clinical Neurosurgery Volume 63, Proceedings of the Congress of Neurological Surgeons 2015 Annual Meeting." Neurosurgery 63.CN_suppl_1 (August 2016): N1-.
PMID
28175390
Source
epmc
Published In
Neurosurgery
Volume
63
Issue
CN_suppl_1
Publish Date
2016
Start Page
N1

127 Multimodality Word-Finding Distinctions in Pediatric Cortical Stimulation Mapping.

Authors
Chou, ND; Serafini, S; Grant, GA; Clyde, M; Komisarow, J; Muh, CR
MLA Citation
Chou, ND, Serafini, S, Grant, GA, Clyde, M, Komisarow, J, and Muh, CR. "127 Multimodality Word-Finding Distinctions in Pediatric Cortical Stimulation Mapping." Neurosurgery 63.CN_suppl_1 (August 2016): 152-.
PMID
28175540
Source
epmc
Published In
Neurosurgery
Volume
63
Issue
CN_suppl_1
Publish Date
2016
Start Page
152

Current and Emerging Surgical Therapies for Severe Pediatric Epilepsies.

The use of epilepsy surgery in various medically resistant epilepsies is well established. For patients with intractable pediatric epilepsy, the role of intracranial electrodes, resective surgery, hemispherectomy, corpus callosotomy, neurostimulation, and multiple subpial transections continues to be very effective in select cases. Newer treatment and diagnostic methods include laser thermal ablation, minimally invasive surgeries, stereo electroencephalography, electrocorticography, and other emerging techniques. This article will review the established and emerging surgical therapies for severe pediatric epilepsies, their respective indications and overall efficacy.

Authors
Muh, CR
MLA Citation
Muh, CR. "Current and Emerging Surgical Therapies for Severe Pediatric Epilepsies." Seminars in pediatric neurology 23.2 (May 30, 2016): 143-150.
PMID
27544471
Source
epmc
Published In
Seminars in Pediatric Neurology
Volume
23
Issue
2
Publish Date
2016
Start Page
143
End Page
150
DOI
10.1016/j.spen.2016.05.005

Preface

Authors
Tomei, KL; Hankinson, TC; Muh, CR; Dumont, AS; Cheshier, SH; Upadhyaya, C; Choudhri, O
MLA Citation
Tomei, KL, Hankinson, TC, Muh, CR, Dumont, AS, Cheshier, SH, Upadhyaya, C, and Choudhri, O. "Preface." Neurosurgery 63 (January 1, 2016): N1-.
Source
scopus
Published In
Neurosurgery
Volume
63
Publish Date
2016
Start Page
N1

Morphometric Analysis of Predictors of Cervical Syrinx Formation in the Setting of Chiari I Malformation.

We performed a morphometric analysis of Chiari I malformations to look for predictors of cervical syrinx formation.Eighteen patients with Chiari I malformation and associated cervical syrinx and 16 patients with Chiari I malformation without associated cervical syrinx were included in the study. Chiari I size was obtained from the radiology report; foramen magnum diameter, cerebellar volume, posterior fossa volume and intracranial volume were calculated using OsiriX software, and average measurements were compared between the two groups.Patients with Chiari I with syrinx had an average tonsillar descent of 13.03 ± 5.31 mm compared to 9.25 ± 3.31 mm in the Chiari I without syrinx group (p < 0.05). Patients with Chiari I and syrinx also showed increased cerebellar crowding with a higher cerebellar volume to posterior fossa volume ratio; however, this difference was not significant (0.83 vs. 0.81; p = 0.1872). No difference between groups was found in posterior fossa volume, intracranial volume and foramen magnum diameter. Therefore, only Chiari I size based on the extent of tonsillar herniation was found to be a determinant of cervical syrinx formation.

Authors
Halvorson, KG; Kellogg, RT; Keachie, KN; Grant, GA; Muh, CR; Waldau, B
MLA Citation
Halvorson, KG, Kellogg, RT, Keachie, KN, Grant, GA, Muh, CR, and Waldau, B. "Morphometric Analysis of Predictors of Cervical Syrinx Formation in the Setting of Chiari I Malformation." Pediatric neurosurgery 51.3 (January 2016): 137-141.
PMID
26871424
Source
epmc
Published In
Pediatric neurosurgery
Volume
51
Issue
3
Publish Date
2016
Start Page
137
End Page
141
DOI
10.1159/000442991

Book Review

Authors
Muh, CR
MLA Citation
Muh, CR. "Book Review." Neurosurgery 77.6 (December 2015): 981-982.
Source
crossref
Published In
Neurosurgery
Volume
77
Issue
6
Publish Date
2015
Start Page
981
End Page
982
DOI
10.1227/NEU.0000000000000910

Preface to Clinical Neurosurgery Volume 62, Proceedings of the Congress of Neurological Surgeons 2014 Annual Meeting.

Authors
Grant, GA; Tomei, KL; Hankinson, TC; Muh, CR; Dumont, AS; Cheshier, SH; Upadhyaya, C; Choudhri, O
MLA Citation
Grant, GA, Tomei, KL, Hankinson, TC, Muh, CR, Dumont, AS, Cheshier, SH, Upadhyaya, C, and Choudhri, O. "Preface to Clinical Neurosurgery Volume 62, Proceedings of the Congress of Neurological Surgeons 2014 Annual Meeting." Neurosurgery 62 Suppl 1 (August 2015): N1-.
PMID
26182050
Source
epmc
Published In
Neurosurgery
Volume
62 Suppl 1
Publish Date
2015
Start Page
N1
DOI
10.1227/neu.0000000000000822

The Chiari Severity Index: A Preoperative Grading System for Chiari Malformation Type 1 COMMENTS

Authors
Cochrane, DD; Muh, CR
MLA Citation
Cochrane, DD, and Muh, CR. "The Chiari Severity Index: A Preoperative Grading System for Chiari Malformation Type 1 COMMENTS." NEUROSURGERY 76.3 (March 2015): 285-285.
Source
wos-lite
Published In
Neurosurgery
Volume
76
Issue
3
Publish Date
2015
Start Page
285
End Page
285

The Chiari Severity Index

Authors
Greenberg, JK; Yarbrough, CK; Radmanesh, A; Godzik, J; Yu, M; Jeffe, DB; Smyth, MD; Park, TS; Piccirillo, JF; Limbrick, DD
MLA Citation
Greenberg, JK, Yarbrough, CK, Radmanesh, A, Godzik, J, Yu, M, Jeffe, DB, Smyth, MD, Park, TS, Piccirillo, JF, and Limbrick, DD. "The Chiari Severity Index." Neurosurgery 76.3 (March 2015): 279-285.
Source
crossref
Published In
Neurosurgery
Volume
76
Issue
3
Publish Date
2015
Start Page
279
End Page
285
DOI
10.1227/NEU.0000000000000608

PTEN status mediates 2ME2 anti-tumor efficacy in preclinical glioblastoma models: Role of HIF1α suppression

Glioblastoma (GBM) is the most common brain cancer and is highly lethal in both adults and children. 2-methoxyestradiol (2ME2) is a microtubule inhibitor that potently inhibits HIF1α, GBM angiogenesis and tumor growth in preclinical models. In patients, 2ME2 exhibits low toxicity and promising but inconsistent efficacy. Given its preclinical potency and its tolerability in patients, we sought to determine whether 2ME2 therapy could be enhanced by addressing resistance via combination therapy, and with biomarkers to identify responsive glioma subgroups. We demonstrate that the PTEN-PI3K axis regulates HIF1α in glioma models. We utilized isogenic-pairs of glioma cell lines, deficient in PTEN or stably reconstituted with PTEN, to determine the role of PTEN in 2ME2 sensitivity in vitro and in vivo. Chou-Talalay synergy studies reveal significant synergy when a pan-PI3K inhibitor is combined with 2ME2. This synergistic activity was correlated with a synergistic suppression of HIF1α accumulation under hypoxic conditions in glioma models. In vivo, 2ME2 markedly inhibited tumor-induced angiogenesis and significantly reduced tumor growth only in a PTEN reconstituted GBM models in both subcutaneous and orthotopic intracranial mouse models. Collectively, these results: (1) suggest that PTEN status predicts sensitivity to 2ME2 and (2) justify exploration of 2ME2 combined with pan-PI3K inhibitors for the treatment of this intractable brain cancer. © 2013 Springer Science+Business Media New York.

Authors
Muh, CR; Joshi, S; Singh, AR; Kesari, S; Durden, DL; Makale, MT
MLA Citation
Muh, CR, Joshi, S, Singh, AR, Kesari, S, Durden, DL, and Makale, MT. "PTEN status mediates 2ME2 anti-tumor efficacy in preclinical glioblastoma models: Role of HIF1α suppression." Journal of Neuro-Oncology 116.1 (January 1, 2014): 89-97.
Source
scopus
Published In
Journal of Neuro-Oncology
Volume
116
Issue
1
Publish Date
2014
Start Page
89
End Page
97
DOI
10.1007/s11060-013-1283-3

Preface

Authors
Grant, GA; Hankinson, T; Muh, C; Dumont, A; Cheshier, S
MLA Citation
Grant, GA, Hankinson, T, Muh, C, Dumont, A, and Cheshier, S. "Preface." Clinical Neurosurgery 61 (January 1, 2014): N1-.
Source
scopus
Published In
Clinical neurosurgery
Volume
61
Publish Date
2014
Start Page
N1

PTEN status mediates 2ME2 anti-tumor efficacy in preclinical glioblastoma models: role of HIF1α suppression.

Glioblastoma (GBM) is the most common brain cancer and is highly lethal in both adults and children. 2-methoxyestradiol (2ME2) is a microtubule inhibitor that potently inhibits HIF1α, GBM angiogenesis and tumor growth in preclinical models. In patients, 2ME2 exhibits low toxicity and promising but inconsistent efficacy. Given its preclinical potency and its tolerability in patients, we sought to determine whether 2ME2 therapy could be enhanced by addressing resistance via combination therapy, and with biomarkers to identify responsive glioma subgroups. We demonstrate that the PTEN-PI3K axis regulates HIF1α in glioma models. We utilized isogenic-pairs of glioma cell lines, deficient in PTEN or stably reconstituted with PTEN, to determine the role of PTEN in 2ME2 sensitivity in vitro and in vivo. Chou-Talalay synergy studies reveal significant synergy when a pan-PI3K inhibitor is combined with 2ME2. This synergistic activity was correlated with a synergistic suppression of HIF1α accumulation under hypoxic conditions in glioma models. In vivo, 2ME2 markedly inhibited tumor-induced angiogenesis and significantly reduced tumor growth only in a PTEN reconstituted GBM models in both subcutaneous and orthotopic intracranial mouse models. Collectively, these results: (1) suggest that PTEN status predicts sensitivity to 2ME2 and (2) justify exploration of 2ME2 combined with pan-PI3K inhibitors for the treatment of this intractable brain cancer.

Authors
Muh, CR; Joshi, S; Singh, AR; Kesari, S; Durden, DL; Makale, MT
MLA Citation
Muh, CR, Joshi, S, Singh, AR, Kesari, S, Durden, DL, and Makale, MT. "PTEN status mediates 2ME2 anti-tumor efficacy in preclinical glioblastoma models: role of HIF1α suppression." J Neurooncol 116.1 (January 2014): 89-97.
PMID
24162827
Source
pubmed
Published In
Journal of Neuro-Oncology
Volume
116
Issue
1
Publish Date
2014
Start Page
89
End Page
97
DOI
10.1007/s11060-013-1283-3

The 62nd Annual Meeting of the Congress of Neurological Surgeons was held in Chicago, Illinois from October 6-10, 2012. Preface.

Authors
Grant, GA; Hankinson, T; Muh, C; Dumont, A
MLA Citation
Grant, GA, Hankinson, T, Muh, C, and Dumont, A. "The 62nd Annual Meeting of the Congress of Neurological Surgeons was held in Chicago, Illinois from October 6-10, 2012. Preface." Neurosurgery 60 Suppl 1 (August 1, 2013).
Source
scopus
Published In
Neurosurgery
Volume
60 Suppl 1
Publish Date
2013

The 62nd Annual Meeting of the Congress of Neurological Surgeons was held in Chicago, Illinois from October 6-10, 2012. Preface.

Authors
Grant, GA; Hankinson, T; Muh, C; Dumont, A
MLA Citation
Grant, GA, Hankinson, T, Muh, C, and Dumont, A. "The 62nd Annual Meeting of the Congress of Neurological Surgeons was held in Chicago, Illinois from October 6-10, 2012. Preface." Neurosurgery 60 Suppl 1 (August 2013): v-.
PMID
23839472
Source
epmc
Published In
Neurosurgery
Volume
60 Suppl 1
Publish Date
2013
Start Page
v
DOI
10.1227/neu.0000000000000006

Preface

Authors
Grant, GA; Hankinson, T; Muh, C; Dumont, A
MLA Citation
Grant, GA, Hankinson, T, Muh, C, and Dumont, A. "Preface." Neurosurgery 60.SUPPL. 1 (2013): V-.
Source
scival
Published In
Neurosurgery
Volume
60
Issue
SUPPL. 1
Publish Date
2013
Start Page
V
DOI
10.1227/NEU.0000000000000006

Preface

Authors
Grant, GA; Hankinson, T; Muh, C; Dumont, A
MLA Citation
Grant, GA, Hankinson, T, Muh, C, and Dumont, A. "Preface." Clinical Neurosurgery 59 (December 1, 2012).
Source
scopus
Published In
Clinical neurosurgery
Volume
59
Publish Date
2012

Traumatic brain injury and hypothermia RESPONSE

Authors
Harris, OA; Surles, MC; Muh, CR
MLA Citation
Harris, OA, Surles, MC, and Muh, CR. "Traumatic brain injury and hypothermia RESPONSE." JOURNAL OF NEUROSURGERY 116.5 (May 2012): 1160-1160.
Source
wos-lite
Published In
Journal of neurosurgery
Volume
116
Issue
5
Publish Date
2012
Start Page
1160
End Page
1160

Growth Hormone-Secreting Tumors

Authors
Muh, CR; Ioachimescu, AG; Oyesiku, NM
MLA Citation
Muh, CR, Ioachimescu, AG, and Oyesiku, NM. "Growth Hormone-Secreting Tumors." Schmidek and Sweet Operative Neurosurgical Techniques: Indications, Methods, and Results: Sixth Edition. March 1, 2012. 215-220.
Source
scopus
Volume
1
Publish Date
2012
Start Page
215
End Page
220
DOI
10.1016/B978-1-4160-6839-6.10018-8

Response

Authors
Harris, OA; Surles, MC; Muh, CR
MLA Citation
Harris, OA, Surles, MC, and Muh, CR. "Response." Journal of Neurosurgery 116.5 (2012): 1160--.
Source
scival
Published In
Journal of neurosurgery
Volume
116
Issue
5
Publish Date
2012
Start Page
1160-
DOI
10.3171/2009.8.JNS09929

Preface

Authors
Grant, GA; Hankinson, T; Muh, C; Dumont, A
MLA Citation
Grant, GA, Hankinson, T, Muh, C, and Dumont, A. "Preface." Clinical Neurosurgery 59 (2012): v-.
Source
scival
Published In
Clinical neurosurgery
Volume
59
Publish Date
2012
Start Page
v

Inflammatory pseudotumor of the lateral ventricle in a pediatric patient.

Inflammatory pseudotumor (IP) is a benign process that most commonly occurs in the lung and orbit. Extension into the central nervous system is extremely rare, and primary intraventricular lesions of the lateral ventricles are even more infrequent with only 2 cases reported in pediatric patients to date. Here, the authors present an unusual case of IP occurring in a 16-year-old female presenting with a 2-week history of progressive headaches and vomiting, without focal neurological deficits or radiographic evidence of hydrocephalus. The patient underwent left parietal craniotomy and complete resection of the tumor, with no signs of recurrence at 3-month follow-up. Although the rarity of intraventricular IP in pediatric patients can make its initial identification difficult, IP should be considered as a potential diagnosis in this population wherein good outcomes may be achieved following surgical resection.

Authors
Choi, BD; Hodges, TR; Grant, GA; Fuchs, HE; Cummings, TJ; Muh, CR
MLA Citation
Choi, BD, Hodges, TR, Grant, GA, Fuchs, HE, Cummings, TJ, and Muh, CR. "Inflammatory pseudotumor of the lateral ventricle in a pediatric patient." Pediatr Neurosurg 48.6 (2012): 374-378.
PMID
23948719
Source
pubmed
Published In
Pediatric neurosurgery
Volume
48
Issue
6
Publish Date
2012
Start Page
374
End Page
378
DOI
10.1159/000353609

Pituitary tumors: Diagnosis and management

Authors
Muh, CR; Oyesiku, NM
MLA Citation
Muh, CR, and Oyesiku, NM. "Pituitary tumors: Diagnosis and management." Principles of Neurological Surgery (2012): 621-644.
Source
scival
Published In
Principles of Neurological Surgery
Publish Date
2012
Start Page
621
End Page
644
DOI
10.1016/B978-1-4377-0701-4.00040-3

Clinical problem solving: monster on the hook--case problems in neurosurgery.

BACKGROUND AND OBJECTIVE: Nonfunctioning and functioning pituitary tumors can present in numerous ways. They may be difficult to diagnose correctly and, even with proper treatment, may lead to complications. METHODS: We present the case of a patient who presented with a large, invasive sellar mass and underwent both medical and surgical treatment for this lesion. The patient's course did not progress as was expected from his initial workup. RESULTS: The patient's history, physical examination, laboratory values, pathologic specimens, and radiologic findings are discussed. His management before, during, and after medical therapy and surgery is reviewed by pituitary experts from 2 different institutions. Aspects of diagnosis and management of sellar lesions are presented and reviewed in the literature. CONCLUSION: Neurosurgeons frequently treat patients with sellar lesions and should remember that despite modern laboratory, pathologic, and radiologic techniques, the diagnosis and treatment of these lesions is not always clear.

Authors
Muh, CR; Boulis, NM; Chandler, WF; Barkan, AL; Mosunjac, MB; Oyesiku, NM
MLA Citation
Muh, CR, Boulis, NM, Chandler, WF, Barkan, AL, Mosunjac, MB, and Oyesiku, NM. "Clinical problem solving: monster on the hook--case problems in neurosurgery." Neurosurgery 68.3 (March 2011): E874-E882. (Review)
PMID
21311284
Source
pubmed
Published In
Neurosurgery
Volume
68
Issue
3
Publish Date
2011
Start Page
E874
End Page
E882
DOI
10.1227/NEU.0b013e318207ac0b

Discrete cerebral hypothermia in the management of traumatic brain injury: a randomized controlled trial.

OBJECT: Hypothermia has been extensively evaluated in the management of traumatic brain injury (TBI), but no consensus as to its effectiveness has yet been reached. Explanatory hypotheses include a possible confounding effect of the neuroprotective benefits by adverse systemic effects. To minimize the systemic effects, the authors evaluated a selective cerebral cooling system, the CoolSystem Discrete Cerebral Hypothermia System (a "cooling cap"), in the management of TBI. METHODS: A prospective randomized controlled clinical trial was conducted at Grady Memorial Hospital, a Level I trauma center. Adults admitted with severe TBI (Glasgow Coma Scale [GCS] score < or = 8) were eligible. Patients assigned to the treatment group received the cooling cap, while those in the control group did not. Patients in the treatment group were treated with selective cerebral hypothermia for 24 hours, then rewarmed over 24 hours. Their intracranial and bladder temperatures, cranial-bladder temperature gradient, Glasgow Outcome Scale (GOS) and Functional Independence Measure (FIM) scores, and mortality rates were evaluated. The primary outcome was to establish a cranial-bladder temperature gradient in those patients with the cooling cap. The secondary outcomes were mortality and morbidity per GOS and FIM scores. RESULTS: The cohort comprised 25 patients (12 in the treatment group, 13 controls). There was no significant intergroup difference in demographic data or median GCS score at enrollment (treatment group 3.0, controls 3.0; p = 0.7). After the third hour of the study, the mean intracranial temperature of the treatment group was significantly lower than that of the controls at all time points except Hours 4 (p = 0.08) and 6 (p = 0.08). However, the target intracranial temperature of 33 degrees C was achieved in only 2 patients in the treatment group. The mean intracranial-bladder temperature gradient was not significant for the treatment group (p = 0.07) or the controls (p = 0.67). Six (50.0%) of 12 patients in the treatment group and 4 (30.8%) of 13 in the control group died (p = 0.43). The medians of the maximum change in GOS and FIM scores during the study period (28 days) for both groups were 0. There was no significant difference in complications between the groups (p value range 0.20-1.0). CONCLUSIONS: The cooling cap was not effective in establishing a statistically significant cranial-bladder temperature gradient or in reaching the target intracranial temperature in the majority of patients. No significant difference was achieved in mortality or morbidity between the 2 groups. As the technology currently stands, the Discrete Cerebral Hypothermia System cooling cap is not beneficial for the management of TBI. Further refinement of the equipment available for the delivery of selective cranial cooling will be needed before any definite conclusions regarding the efficacy of discrete cerebral hypothermia can be reached.

Authors
Harris, OA; Muh, CR; Surles, MC; Pan, Y; Rozycki, G; Macleod, J; Easley, K
MLA Citation
Harris, OA, Muh, CR, Surles, MC, Pan, Y, Rozycki, G, Macleod, J, and Easley, K. "Discrete cerebral hypothermia in the management of traumatic brain injury: a randomized controlled trial." J Neurosurg 110.6 (June 2009): 1256-1264.
PMID
19249933
Source
pubmed
Published In
Journal of neurosurgery
Volume
110
Issue
6
Publish Date
2009
Start Page
1256
End Page
1264
DOI
10.3171/2009.1.JNS081320

Headaches, rapidly progressive visual loss, and bilateral disc edema

Authors
Muh, CR; Dion, J; Newman, NJ; Biousse, V
MLA Citation
Muh, CR, Dion, J, Newman, NJ, and Biousse, V. "Headaches, rapidly progressive visual loss, and bilateral disc edema." Reviews in Neurological Diseases 6.4 (2009): E141-E145.
Source
scival
Published In
Reviews in Neurological Diseases
Volume
6
Issue
4
Publish Date
2009
Start Page
E141
End Page
E145
DOI
10.3909/rind0236b

Discrete cerebral hypothermia in the management of traumatic brain injury (Journal of Neurosurgery (2009) (4) DOI: 10.3171/2009.1.JNS081320)

Authors
Harris, OA; Muh, CR
MLA Citation
Harris, OA, and Muh, CR. "Discrete cerebral hypothermia in the management of traumatic brain injury (Journal of Neurosurgery (2009) (4) DOI: 10.3171/2009.1.JNS081320)." Journal of Neurosurgery 110.6 (2009): 1322--.
Source
scival
Published In
Journal of neurosurgery
Volume
110
Issue
6
Publish Date
2009
Start Page
1322-
DOI
10.3171/2009.1.JNS081320a

PI-3 kinase-PTEN signaling node: an intercept point for the control of angiogenesis.

Angiogenesis is tightly regulated by opposing mechanisms in mammalian cells and is controlled by the angiogenic switch. Other review articles have described a central role for the PTEN/PI-3 kinase/AKT signaling node in the coordinate control of cell division, tumor growth, apoptosis, invasion and cellular metabolism [1, 2]. In this review, we focus on literature that supports the PTEN/PI-3 kinase/AKT signaling node as a major control point for the angiogenic switch in both the on and off positions. We also discuss the rationale for designing small molecule drugs that target the PTEN/PI-3 kinase/AKT signaling node for therapeutic intervention. Our hypothesis is that, instead of inhibiting one cell surface receptor, such as VEGFR2 with bevacizumab (Avastin), thereby leaving a significant number of receptors free to pulse angiogenic signals, a more effective strategy may be to regulate signaling through an intercept node where redundant cell surface receptor signals converge to transmit important signaling events within the cell. This therapeutic configuration brings coordinate control over multiple cell surface receptors in concert with a physiologic response which may combine arrest of cell cycle progression with growth inhibition and the induction of genes involved in specialized functions such as movement, which are all required for the complex process of angiogenesis to occur in a temporal-spatial paradigm.

Authors
Castellino, RC; Muh, CR; Durden, DL
MLA Citation
Castellino, RC, Muh, CR, and Durden, DL. "PI-3 kinase-PTEN signaling node: an intercept point for the control of angiogenesis." Curr Pharm Des 15.4 (2009): 380-388. (Review)
PMID
19199965
Source
pubmed
Published In
Current Pharmaceutical Design
Volume
15
Issue
4
Publish Date
2009
Start Page
380
End Page
388

Headaches, rapidly progressive visual loss, and bilateral disc edema.

The diagnosis and management of a 28-year-old obese woman who presented with neck pain, headache, and rapidly progressive visual loss is discussed here. Results of her initial general examination were normal. Thorough medical follow-up resulted in a rare diagnosis.

Authors
Muh, CR; Dion, J; Newman, NJ; Biousse, V
MLA Citation
Muh, CR, Dion, J, Newman, NJ, and Biousse, V. "Headaches, rapidly progressive visual loss, and bilateral disc edema." Rev Neurol Dis 6.4 (2009): E133-E134.
PMID
20065924
Source
pubmed
Published In
Reviews in Neurological Diseases
Volume
6
Issue
4
Publish Date
2009
Start Page
E133
End Page
E134

Discrete cerebral hypothermia in the management of severe traumatic brain

Authors
Harris, O; Muh, CR; Surles, M; Pan, Y; Rozycki, G; Macleod, J; Easley, K
MLA Citation
Harris, O, Muh, CR, Surles, M, Pan, Y, Rozycki, G, Macleod, J, and Easley, K. "Discrete cerebral hypothermia in the management of severe traumatic brain." June 2008.
Source
wos-lite
Published In
Neurosurgery
Volume
62
Issue
6
Publish Date
2008
Start Page
1413
End Page
1413

Prolonged convection-enhanced delivery into the rat brainstem - Comments

Authors
Bruce, JN; Muh, CR; Piepmeier, JM; Rock, JP
MLA Citation
Bruce, JN, Muh, CR, Piepmeier, JM, and Rock, JP. "Prolonged convection-enhanced delivery into the rat brainstem - Comments." NEUROSURGERY 52.2 (February 2003): 393-394.
Source
wos-lite
Published In
Neurosurgery
Volume
52
Issue
2
Publish Date
2003
Start Page
393
End Page
394

Prolonged convection-enhanced delivery into the rat brainstem

OBJECTIVE: Prolonged convection-enhanced delivery was used in an attempt to achieve large volumes of distribution (Vd) in the rat brainstem. Clinical assessment and histological analysis were performed to establish the safety of this approach. METHODS: For evaluation of Vd, 10 rats underwent stereotactic cannula placement into the brainstem. Five rats underwent a 24-hour infusion (volume of infusion [Vi], 200 μl), and 5 rats underwent a 7-day infusion (Vi, 2 ml) of fluorescein isothiocyanate-dextran. Serial brainstem sections were imaged with ultraviolet illumination, and Vd was assessed. For assessment of clinical tolerance, 30 additional rats underwent chronic infusions of an isotonic saline solution into the brainstem. Serial neurological examinations were performed, followed by histological analysis after the animals' death. RESULTS: No animal demonstrated clinically recognized neurological deficits. Foci of organizing necrosis were limited to the site of infusion and cannula tract. Vd increased linearly with increasing Vi (range, 24.8-130.6 mm3). Maximal cross sectional area of fluorescence and craniocaudal extent of fluorescence increased with increasing Vi. Fluorescence was detected throughout the entire brainstem beyond the compact area of highly concentrated tracer. CONCLUSION: Prolonged convection-enhanced delivery can be applied safely in the rat brainstem with no recognized limitations of Vd and minimal histological changes beyond the site of infusion. Chronic brainstem infusions may enhance the potential application of convection-enhanced delivery for therapeutic purposes in treating diffuse pontine gliomas.

Authors
Occhiogrosso, G; Edgar, MA; Sandberg, DI; Souweidane, MM; Bruce, JN; Muh, CR; Piepmeier, JM; Rock, JP
MLA Citation
Occhiogrosso, G, Edgar, MA, Sandberg, DI, Souweidane, MM, Bruce, JN, Muh, CR, Piepmeier, JM, and Rock, JP. "Prolonged convection-enhanced delivery into the rat brainstem." Neurosurgery 52.2 (2003): 388-394.
PMID
12535369
Source
scival
Published In
Neurosurgery
Volume
52
Issue
2
Publish Date
2003
Start Page
388
End Page
394

Preface

Authors
Alster, TS
MLA Citation
Alster, TS. "Preface." Dermatologic Therapy 13.1 (January 2000): 1-1.
Source
crossref
Published In
Dermatologic Therapy
Volume
13
Issue
1
Publish Date
2000
Start Page
1
End Page
1
DOI
10.1046/j.1529-8019.2000.00001.x
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Research Areas:

  • Adolescent
  • Biopsy
  • Brain Injuries
  • Brain--Magnetic resonance imaging
  • Cerebrospinal Fluid Shunts
  • Craniotomy
  • Disease Models, Animal
  • Epilepsy
  • Epilepsy in children
  • Equipment Design
  • Feasibility Studies
  • Follow-Up Studies
  • Glasgow Outcome Scale
  • Glioblastoma multiforme
  • Humans
  • Hypothermia, Induced
  • Neoplasm Invasiveness
  • Neovascularization, Pathologic
  • Neovascularization, Physiologic
  • Neurosurgery
  • PTEN Phosphohydrolase
  • Phosphatidylinositol 3-Kinases
  • Pituitary Neoplasms
  • Prospective Studies
  • Signal Transduction
  • Survival Rate
  • Tomography Scanners, X-Ray Computed
  • Treatment Outcome
  • Xenograft Model Antitumor Assays
  • Young Adult